[Association between air pollution exposure and metabolic dysfunction-associated steatotic liver disease in adults in China].
Objective: To analyze the associations of exposure to single pollutants and their mixture with metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with significant liver fibrosis in adults in China. Methods: A total of 23 806 participants from the third resurvey of the China Kadoorie Biobank were included. An elastic-net logistic regression model was used to calculate the weighted environmental risk score (WERS). Logistic regression models were used to evaluate the associations of the exposures to single pollutant [fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide (NO2), and warm-season ozone (O3)], and their mixture (WERS) with the risk for MASLD and MASLD with significant liver fibrosis. Restricted cubic spline models were used to evaluate non-linear relationships. Logistic regression models were also used to estimate the population attributable fraction (PAF) for air pollutants and major risk factors. Results: The mean age of the study participants was (65.3±9.1) years. Among them, 13 428 had MASLD, including 2 457 with significant liver fibrosis. Exposure to PM2.5, PM10, NO2, and warm-season O3 was positively associated with MASLD risk, with ORs of 1.27 (95%CI: 1.05-1.53), 1.77 (95%CI: 1.36-2.31), 1.20 (95%CI: 1.08-1.33), and 1.53 (95%CI: 1.20-1.95) per 1-SD increase, respectively. PM2.5 showed a non-linear association with MASLD risk (P for nonlinear=0.007). The association between PM2.5 and MASLD was mild at low exposure levels but increased obviously at higher concentrations. PM10 and warm-season O3 exposures were positively associated with significant liver fibrosis in MASLD patients. Each 1-unit increase in WERS (representing simultaneous 1-SD increases in the four pollutants) was associated with a 40% higher risk for MASLD (95%CI: 18%-65%) and a 42% higher risk for significant liver fibrosis (95%CI: 1%-100%). Compared with people with low exposure to air pollutants, the PAFs for MASLD in those with higher exposures to PM2.5, PM10, and warm-season O3 ranged from 25.4% to 66.4%. Conclusion: Exposures to PM2.5, PM10, NO2, and warm-season O3, as well as their mixture, were associated with increased risk for MASLD and MASLD with significant liver fibrosis in adults in China.
Authors
Huang Huang, Lyu Lyu, Yu Yu, Sun Sun, Pei Pei, Du Du, Chen Chen, Chen Chen, Lyu Lyu, Li Li, Pang Pang
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